Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards
A Medicare card screenshot

Life Health > Health Insurance > Medicare Planning

House Passes Medicare Preauthorization Bill by Voice Vote

Your article was successfully shared with the contacts you provided.

What You Need to Know

  • H.R. 3173 would create an electronic preauthorization process and could lead to instant approvals for some procedures.
  • Insurance industry groups have supported the bill.
  • The bill has had strong bipartisan support in both the House and the Senate.

Members of the House today passed H.R. 3173 — the Improving Seniors’ Timely Access to Care Act — by a voice vote.

The bill would change the rules Medicare Advantage plans use when determining ahead of time whether they will pay for a course of care recommended by a patient’s physician.

Both H.R. 3173 and the Senate companion bill, S. 3018, have had strong support from both Democrats and Republicans.

But Rep. Kevin Brady, R-Texas, who is the highest-ranking Republican on the House Ways and Means Committee, which shapes federal spending, today warned in a statement that he has concerns about a Congressional Budget Office estimate that the rule changes could cost $16.2 billion over 10 years.

What It Means

H.R. 3173 could become law, but the House voice vote approving it does not mean that final passage through Congress is a sure thing.

The Background

The Medicare Advantage program gives private insurers a way to offer Medicare enrollees coverage that looks more like ordinary commercial health coverage, and less like original Medicare coverage, which was developed more than 50 years ago and has elaborate rules for sharing costs with the enrollees.

In an effort to improve the quality of care and reduce unnecessary use of care, Medicare Advantage plans often use preauthorization programs and other rules and programs to see whether the requested drugs, procedures and other forms of care proposed appear to make sense.

Doctors have argued that, in practice, many of the preauthorization programs are slow, intrusive and demeaning, and may require them to explain their recommendations to care review workers who know nothing about the doctors’ fields of practice.

Rep. Suzan DelBene, D-Wash., introduced H.R. 3173, the House Medicare Advantage preauthorization rule change bill, in May 2021. It has 189 Democratic co-sponsors and 134 Republican co-sponsors.

Sen. Roger Marshall, R-Kansas, introduced the Senate version, S. 3018, in October 2021. That bill now has 21 Democratic co-sponsors and 21 Republican co-sponsors.

Both bills would require Medicare Advantage plans to adopt electronic prior authorization systems that meet federal standards, provide instant decisions for items and services that are typically approved and publish preauthorization program performance data every year.

The sponsors have won support from insurance organizations, such as the Better Medicare Alliance and America’s Health Insurance Plans, as well as from patient and health care provider groups.


H.R. 3173 could sail through the Senate and onto the desk of President Joe Biden.

One possible remaining source of resistance to quick passage is the $16.2 billion CBO bill cost estimate.

Brady said in his statement that, because of the bill’s cost, Congress must find spending cuts or sources of revenue to offset the impact of the bill on the federal budget deficit.

“I had expected this basic responsibility would have occurred in the House,” Brady said. “Now I strongly urge the Senate to work with us to resolve the cost issue, so this vital bill becomes law.”

Brady’s statement could be a sign that discussions about “pay-fors” could be a source of friction as H.R. 3173 heads toward the Senate floor.

(Image: CMS)


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.